Older adults tak­ing opi­oids at risk: re­port

Hospi­tal stays longer for opi­oid poi­son­ing

The Peterborough Examiner - - Canada & World - SH­ERYL UBELACKER

TORONTO — When most peo­ple think about opi­oid over­doses, it’s typ­i­cally a younger per­son that comes to mind. But it’s of­ten older Cana­di­ans who bear the brunt of detri­men­tal ef­fects re­lated to the pow­er­ful nar­cotics.

In fact, about 30 per cent of all opi­oid-re­lated deaths in Canada in 2017 oc­curred among those aged 50 and older, while adults 65-plus had the high­est rates of hos­pi­tal­iza­tion due to tox­i­c­ity from the painkillers, says a re­port by the Na­tional Ini­tia­tive for the Care of the El­derly (NICE), re­leased Wed­nes­day in Ot­tawa.

“The at­ten­tion seems to be on the younger pop­u­la­tion, whereas the data sug­gest that it’s older adults who are just as — if not more — ad­versely af­fected in this opi­ate cri­sis,” said geri­atric ad­dic­tion spe­cial­ist Mar­i­lyn WhiteCamp­bell, who col­lab­o­rated on the study.

“And that’s where there’s this idea of the in­vis­i­ble epi­demic, be­cause it’s not re­ally seen as an older per­son’s prob­lem.”

Adults aged 65-plus con­sis­tently have the high­est rates of hos­pi­tal­iza­tion due to opi­oid poi­son­ing, the re­port found.

While older adults rep­re­sented 16 per cent of the pop­u­la­tion in 2014-15, they ac­counted for about 25 per cent of all hospi­tal ad­mis­sions due to opi­oid tox­i­c­ity.

Hospi­tal stays for opi­oid poi­son­ing were also more pro­longed for those aged 50 and up — eight days longer on av­er­age — com­pared with those in other age brack­ets, says the re­port, which was com­piled fol­low­ing an in­depth re­view of re­search on the topic.

Ac­ci­den­tal opi­oid tox­i­c­ity that oc­curred as a re­sult of treat­ment with pre­scribed opi­oids, such as mor­phine, hy­dro­mor­phone and the fen­tanyl patch, ac­counted for a quar­ter of poi­son­ings among older Cana­di­ans.

But White-Campbell be­lieves the ac­tual fig­ure may be higher.

“Is the per­son com­ing to the hospi­tal be­cause they’ve had a fall and a frac­ture or are they com­ing in be­cause of an opi­ate poi­son­ing?” she said.

Older peo­ple who take the painkillers are known to have a greater risk for falls due to the drugs’ ef­fects on bal­ance and cog­ni­tion.

Dr. Samir Sinha, the di­rec­tor of geri­atrics at Si­nai Health Sys­tems and the Univer­sity Health Net­work in Toronto, said older Cana­di­ans are pre­scribed opi­oids more of­ten than their younger coun­ter­parts be­cause they usu­ally have more pain-caus­ing health con­di­tions, such as chronic arthri­tis.

But be­cause there are changes in how the body me­tab­o­lizes med­i­ca­tions as a per­son ages, tol­er­ance for drugs like opi­oids can de­cline.

“We break down med­i­ca­tions more slowly as we get older and our liv­ers age,” he said. “That means the same dose of opi­oids that might have worked for you when you were 50 might ac­tu­ally be toxic when you’re 60.

“That’s not a mat­ter of you tak­ing too much, it’s just that your body can only tol­er­ate so much and only needs so much. So if we don’t ad­just those med­i­ca­tions, you’re at higher risk of opi­oid tox­i­c­ity.”

Cit­ing 2017 statis­tics, the re­port showed 92 per cent of opi­oidrelated deaths across all ages were deemed to be ac­ci­den­tal. But among deaths in which med­i­cal ex­am­in­ers de­ter­mined the drugs had been de­lib­er­ately in­gested with the in­tent to die, a high per­cent­age of fa­tal­i­ties oc­curred among those aged 50 and older.

The same dose of opi­oids that might have worked for you when you were 50 might ac­tu­ally be toxic when you’re 60.

DR. SAMIR SINHA

Univer­sity Health Net­work

GRAEME ROY THE CANA­DIAN PRESS

Younger peo­ple may come to mind when peo­ple think about opi­oid over­doses. But of­ten older Cana­di­ans are af­fected by the nar­cotics.

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